Hales-Kharazmi Alice, Hirsch Nina, Kelleman Michael, Slesnick Timothy, Deshpande Shriprasad R
1Department of Pediatrics,Division of Cardiology,Children's Healthcare of Atlanta,Emory University School of Medicine,Atlanta, Georgia,United States of America.
2Philadelphia College of Osteopathic Medicine - Georgia Campus,Atlanta, Georgia,United States of America.
Cardiol Young. 2018 Mar;28(3):377-385. doi: 10.1017/S1047951117001093. Epub 2017 Dec 14.
The diagnostic role of cardiac MRI in myocarditis is evolving, however with extremely limited data in paediatrics. The goal of this study was to assess the utility of cardiac MRI in paediatric myocarditis and present a new prognostic score for risk stratification.
The present study is a retrospective investigation of children with a clinical diagnosis of myocarditis, including analysis of demographics, clinical presentation, diagnostic studies, including cardiac MRI, and outcomes.
A total of 44 patients met the inclusion criteria, of whom 20 had undergone cardiac MRI. Patients who underwent cardiac MRI were older (median 15.6 versus 11.1 years, p=0.004), had a shorter length of hospital stay (median 4.0 versus 12.5 days, p=0.004), had overall less-severe illness at presentation as evidenced by a higher left-ventricular ejection fraction on echocardiography, had lower peak brain-type natriuretic peptide, were less likely to require advanced mechanical support, and were less likely to experience cardiac death or transplant. In patients who had undergone cardiac MRI, the most common findings were increased early gadolinium enhancement (n=9) or late gadolinium enhancement (n=9). Cardiac MRI findings did not predict a worse outcome. Independent predictors of the need for heart-failure medications at 1-year follow-up included inotrope requirement, extracorporeal membrane oxygenator requirement, and antiarrhythmic requirement at presentation (p<0.05).
In paediatric myocarditis, cardiac MRI is not used uniformly, has a low yield, and does not predict worse outcomes. Future research should evaluate clinical decision-making and the cost-benefit analysis of cardiac MRI in the diagnosis of paediatric myocarditis.
心脏磁共振成像（MRI）在心肌炎诊断中的作用正在不断演变，但儿科方面的数据极为有限。本研究的目的是评估心脏MRI在儿童心肌炎中的应用价值，并提出一种新的预后评分系统用于风险分层。
本研究是一项对临床诊断为心肌炎的儿童进行的回顾性调查，包括对人口统计学、临床表现、诊断研究（包括心脏MRI）及预后的分析。
共有44例患者符合纳入标准，其中20例接受了心脏MRI检查。接受心脏MRI检查的患者年龄较大（中位数15.6岁对11.1岁，p = 0.004），住院时间较短（中位数4.0天对12.5天，p = 0.004），就诊时总体病情较轻，这可通过超声心动图显示的较高左心室射血分数得到证明，脑钠肽峰值较低，需要高级机械支持的可能性较小，发生心脏死亡或移植的可能性也较小。在接受心脏MRI检查的患者中，最常见的表现是早期钆增强增加（n = 9）或晚期钆增强增加（n = 9）。心脏MRI表现并不能预测更差的预后。1年随访时需要使用心力衰竭药物的独立预测因素包括就诊时对血管活性药物的需求、体外膜肺氧合需求和抗心律失常药物需求（p < 0.05）。
在儿童心肌炎中，心脏MRI的使用并不统一，阳性率较低，且不能预测更差的预后。未来的研究应评估心脏MRI在儿童心肌炎诊断中的临床决策及成本效益分析。
